It was the Friday before Christmas when it happened. The last working day for many and a day of high spirits, excitement and joy. But for me, on this particular day, I knew I couldn’t do my job.
During the previous two years or so, I had continued to work while caring for my parents as each of them journeyed through terminal illnesses. Admittedly, the lack of control and flexibility over my day-to-day work load was challenging and I envied my sisters who, both in office jobs, enjoyed the liberty to postpone tasks on a ‘bad day’ to the following day. My colleagues provided the safe space to offload. At times, I had difficulty accurately evaluating risk, and so using my colleagues as ‘sounding-boards’ ensured I wasn’t becoming risk-averse in my management decisions.
Some consultations had become more emotionally demanding than usual. For example, I recall a patient informing me, ‘You’re far too young to have any idea how hard it is to contemplate losing a parent.’ Every muscle in my body tensed, my skin was on fire and the only sound I could hear was the pounding of my heart.
I was working as the chair of my local CCG, which became a place of sanctuary – somewhere I could immerse myself in working for the good of patients without the emotional investment of the doctor-patient relationship. I have since left the role to embrace other opportunities, but I still value the way it made me more resilient during this period.
As my father’s condition worsened, I continued to to drag myself out of bed every morning with the mantra: ‘Come on, Lisa, one foot in front of the other.’ I had no choice but to go on. Despite the long-term involvement in emotionally-demanding situations both personally and professionally, my head was above water and I knew that I continued to offer my patients a good, safe service.
One particular Friday morning was different.
‘Driving Home For Christmas’ was playing on the radio as I drove to work and, as the first verse turned into the chorus and images of my welcoming, warm, full of life childhood home contrasted with the empty cold shell it had become, I turned from being a kind, caring GP to an utterly exhausted twice-bereaved person who just couldn’t face another patient
I couldn’t shoulder anyone else’s problems, had nothing left to give emotionally or physically and could no longer put one foot in front of the other. For the first time, I didn’t want to see the world from a patient’s perspective. I wanted everyone to see the world from my perspective – a dark grey world.
I could feel awaited tears of grief fighting for freedom as I informed a receptionist that I had ‘run into a wall’. She scuttled out, looking confused, but within minutes a GP colleague was by my side and my surgery cancelled.
There was no ‘breakdown’, as such. Sometimes being a GP and managing the emotional demand is like a field in the rain: it can take only so much before it gets waterlogged. It had been raining in my personal and professional life for a long time and I had reached capacity.
Having a couple of weeks off to grieve for my parents was all I needed to be able to care again. It is testament to the supportive nature of my practice that it wasn’t a work incident that caused me to feel like I could no longer go on, but a Chris Rea record.
However, with the increasing workload, demands and diminishing morale in general practice, I know that I wasn’t the only GP feeling unable to face another patient.
It comes as no surprise that a Pulse survey has shown up to 43% of us are at high risk of burnout and one in 10 has taken time off due to stress or burnout in the last 12 months. Following the success of Pulse’s ‘Battling Burnout’ campaign, it is great news that all GPs will now be provided with occupational health support if they need it. But prevention is better than cure.
The irony is that as demands increase and morale falls, we stop doing the things that help to keep us effective and extinguish the flames of burnout before they become wild-fires that consume us. We attempt to cope by not taking coffee breaks, saving time by not taking ‘chats’, then skipping lunch breaks too. Work begins to creep into the evenings and the next thing you know, you’re in the surgery on a Sunday night doing paperwork.
We stop making time for discussing challenging consultations and difficult decisions with colleagues. We feel under pressure to rush patients, missing out on the positive mutual reward that comes from the doctor:patient relationship. But coffee breaks, seeking and giving support to colleagues, receiving positive feedback about performance, and working in a supportive environment all help prevent burnout.
Collectively we have the power to determine the culture in which we work. Furthermore, it is within our gift to make small changes to keep us working effectively and create a mutually supportive environment. I promise that it doesn’t take long to stick your head round the door of a colleague’s room and ask how they are.
Dr Lisa Harrod-Rothwell is a GP in Essex and former chair of a local CCG.
1 Maslach, C., Schaufeli, W.B. and Leiter, M.P. (2001) ‘Job burnout’, Annual Review of Psychology, Vol 52, No 1 pp. 397-422